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About Case Management & CMSA

Case Managers are at the center of care delivery for patients. They serve as a patient advocate and resource as well as providing critical information and recommendations to the rest of the care team: physicians, surgeons, nurses, administrators, benefits coordinators, employers and family caregivers. In this role they break down silos, open up new efficient paths for health care delivery and ensure the adequate utilization of resources, all while focusing on the primary goal: effective care of the patient.

The Case Management Society of America is the oldest and largest professional organization dedicated to delivery of care management services across practice settings and care models. CMSA provides educational, networking and professional resources for its members and seeks to connect case managers, products and service providers, consumers and policy makers to ensure optimal delivery of care management services. This site is focused on helping legislators and policy makers better understand the role case management plays in health care delivery and how to ensure patients receive the best care possible.

Announcements

Come to Capitol Hill with fellow CMSA members, CMSA’s Public Policy Committee and Board of Directors to play a direct role in the legislative process by meeting with your House and Senate representatives. In addition, you’ll be able to highlight the critical role that case managers play in healthcare delivery, explore how to utilize your local networks for grassroots legislative success and ensure that case managers are speaking for case managers.

On Nov. 20, 2014, U.S. Senators Tammy Baldwin (D-WI) and Rob Portman (R-OH) introduced the bipartisan Critical Care Assessment and Improvement Act of 2014. The bill calls for a comprehensive evaluation of America’s critical care system with the goal of driving policies that will maximize current federal resources to improve health outcomes for patients in our nation’s intensive care units and to ensure we are prepared for future health emergencies.

CMSA has provided its support for the bill; to read the letter of support, click here.

National Case Management Week Resolution Passes Unanimously in Senate

On Sept. 27, 2013, the United States Senate passed S. Res. 214, a resolution declaring the week of October 13-19, 2013, as "National Case Management Week," to recognize the value of case management in improving healthcare outcomes for patients.

The Issue — Nurse Licensure rules and regulations were formed when nursing was practiced primarily within the boundaries of one or two states.

With the development of managed care, tele-health and mobile populations, nurses are frequently required to work with patients who travel or reside across multiple state lines. Unlike drivers’ licenses, many state nursing licenses are not recognized by other states.

Current Procedural Terminology (CPT) Coding

The Issue — The Case Management Society of America (CMSA) continues to advocate for a change in Current Procedural Terminology (CPT) code currently in place in the 2008 Physician Fee Schedule.

While the current schedule includes codes related to the delivery of case management services, these codes are a Status N, which means they are non-payable by Medicare. CMSA is working with the Centers for Medicare and Medicaid Services (CMS) in support of funding reimbursing the codes.

Read CMSA's May 5, 2010 letter to the National Association of Insurance Commissioners (NAIC) requesting that case management be classified as clinical expenses in the medical loss ratio (MLR).

CMSA urges the NAIC to support the classification of these services as either “medical expenses” or “quality improvement expenses” for the purpose of calculating a health plan’s MLR under the requirements of The Patient Protection and Affordable Care Act (PPACA), PL 111-148

CMSA's Letter to FDA Regarding Bevacizumab

Read CMSA's September 14, 2010 letter to the Food and Drug administration (FDA) in which it implores the FDA to give due consideration to the issue of patient and provider choice as it considers elimination of the indication for use of bevacizumab in the treatment of patients with metastatic HER2-negative breast cancer.

Metastatic breast cancer is an incurable disease that takes the lives of approximately 40,000 women in the United States each year. The decision to remove the indication for this use of bevacizumab effectively eliminates one of the few remaining available treatment options for patients in this dire situation.

What Does Sebelius Resignation Mean for Case Management?

On April 11, 2014, it was announced that Kathleen Sebelius, the U.S. Department of Health and Human Services (HHS) secretary, is resigning after five years in the position. President Obama intends to nominate Sylvia Mathews Burwell, the current director of the U.S. Office of Management and Budget, to the HHS position.

While this is big national news, what does it mean for case management? Here are a few key points about how this change may affect healthcare, you and your patients:

The Burwell resignation offers a fresh start to relations between the Department of Health and Human Services and Congress surrounding topics such as the rollout of the Affordable Care Act. She was confirmed to her current position as Budget Director by a vote of 96-0.

Sylvia Burwell brings a background in economics and the federal budget to HHS. Given that the agency is responsible for spending over $800 billion annually, mostly through Medicare, Medicaid, and Social Security but also through many other health-related programs, her expertise should lead to capable execution of the annual budgets sent to her by Congress.

With midterm elections only seven months away, the resignation may have a small effect on the issue of Obamacare. A new Secretary defuses the Obamacare topic slightly in campaign season.

Almost everyone who works in healthcare is affected by funding or regulations that come under the purview of the Department of Health and Human Services. In addition, almost everyone knows someone who is affected by the Medicare, Medicaid, or Social Security programs. These programs and HHS as a whole will have new leadership soon, allowing the agency to have more time to focus on the programs for which it is responsible instead of controversies, and a new leader with a strong budgetary background to show the way.

Medicare Transitional Care Act of 2012

CMSA shows support for Bill, which is designed to improve transitions of care for high risk Medicare beneficiaries

On September 14, Representatives Earl Blumenauer (D-OR), Thomas Petri (R-WI), Allyson Schwartz (D-PA) and Jan Schakowsky (D-IL) introduced the bipartisan Medicare Transitional Care Act of 2012, legislation that seeks to improve transitions of care for Medicare beneficiaries at highest risk for readmission as they move from the hospital setting to their home, skilled nursing facility or next point of care. The Case Management Society of America is in support of the Bill, which the organization believes would directly address continuity of care problems by increasing patient support and ensuring appropriate follow-up care during and after the transition period.

The legislation incorporates many of NTOCC’s principles, such as aligning the transitional service requirements with NTOCC’s “Seven Essential Intervention Categories”—seven key elements found in evidence-based care interventions— and the integration of all members of the care team in executing effective care transitions.

CMSA Multistate LicensurePosition Statement

The purpose of the CMSA position statement is to alert and to encourage individuals and organizations to aggressively encourage the non-Compact State Boards of Nursing to join the Compact or to encourage federal legislation mandating recognition of nurse licensure across state lines.

Resource Kit

CMSA has prepared a resource kit to help policymakers better understand the role of case managers and the how effective case management services provide better outcomes for patients, controlling health care expenditures and improving the performance of the US healthcare system.

The kit includes easy- to-understand background information and material for individuals new to case management as well as policymakers well versed in health care issues. The information is provided in a variety of formats so you can easily share this material with your colleagues and constituents.

Caregivers Often Have Questions About Medicare

Caregiver resources are available on Medicare.gov/caregivers. These resources provide insights about choosing a drug plan, selecting a hospital, finding local support and care options, and more. And be sure to remind caregivers that many Medicare preventive services are available to their loved one with no co-pay, like an annual wellness visit, immunizations, and some cancer screenings. It’s just another way you can help caregivers.

CMSA's Standards of Practice for Case Management

Download a copy of CMSA's Standards of Practice for Case Management which provides voluntary practice guidelines for the case management industry and are intended to identify and address important foundational knowledge and skills of the case manager within a spectrum of case management practice settings and specialties.